PIEDMONT FLEET SERVICES, INC.

Transcription

1 PIEDMONT FLEET SERVICES, INC. FULL SERVICE TRUCK, TRAILER AND EMERGENCY VEHICLE REPAIR FACILITY ASE CERTIFIED EVT CERTIFIED DOT CERTIFIED VIRGINIA INSPECTION STATION OFFICE (434) FAX (434) APPLICATION FOR EMPLOYMENT (answer all questions-please print) In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or disability. Date of application s(s) Applied for Are you available to work: (Please check all the apply) Full Time Part Time Shift Work Temporary Work Current Address Last First MI SS# How Long Previous Address Previous Address How Long How Long Date of Birth Can you provide proof of age? Yes No (Required for Commercial Drivers) Do you have the legal right to work in the United States? Yes No Have you ever filed an application with us before? Yes No

2 If yes, give date: Have you ever been employed with us before? Yes No If yes, give dates: To Are you now employed? Yes No If yes, may we contact your present employer? Yes No Who referred you? Rate of Pay Expected Have you been convicted of a felony within the last 7 years? Yes No If yes, please explain: Employment History All applicants with a commercial drivers license must provide 10 years of employment information. If EMPLOYER #1 employed for less than 10 years all employment history must be listed. EMPLOYER #2

3 EMPLOYER #3 EMPLOYER #4 EMPLOYER #5 EMPLOYER #6

4 Certifications List any certifications below ASE EVT MANUFACTURER Allison Transmissions CAT Cummins Detroit Diesel Mercedes Engines Hale Pumps Waterous Pumps Spartan Chassis Meritor Heavy Truck Alignment Engine, transmission, series, etc. EXPERIENCE Engine, transmission, Engine, transmission, series, etc. series, etc. Allison Transmissions Hale Pumps CAT Waterous Pumps Cummins Spartan Chassis Detroit Diesel Meritor Mercedes Engines Heavy Truck Align

5 Accident Record & Driving Record Accident Record for Past 3 Years or More (Attach Sheet if More Space is Needed) if None, Write None Nature of Accident Date (Head-On, Rear-End, Upset, Etc.) Fatalities Injuries Last Accident Next Previous Next Previous Next Previous Next Previous Traffic convictions and forfeitures for the past 3 years (other than parking violations) if none, write none Location Date Charge Penalty (Attach sheet if more space is needed) Education Circle Highest Grade Completed: High School: College: Last School Attended City State Driver Qualifications Driver State License # Type Expiration Date Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No Has any license, permit or privilege ever been suspended or revoked? Yes No IF THE ANSWER TO ABOVE IS YES, ATTACH STATEMENT GIVING DETAILS Driving Experience, If None, Write None Class of Equipment Straight Truck Tractor & Semi-Trailer Tractor-Two Trailers Motor Coach School Bus Other Type of Equipment (Van, Tank, Flat, Etc.) Dates Approximate # of Miles

6 List States Operated In For Last Five Years Show Special Courses or Training That Will Help You As A Driver Which Safe Driving Awards Do You Hold and From Whom? Experience & Qualifications Other Show any trucking, transportation or other experience (not listed elsewhere on the application) that may help in you work for this company List courses and training (other than those shown elsewhere in this application) List special equipment or technical materials you can work with (other than those already shown) Note to Applicants: Do not answer this question unless you have been informed about the requirements of the job for which you are applying. Are you capable of performing in a reasonable manner, with or without reasonable accommodation, the activities involved in the job or occupation for which you have applied? Yes No TO BE READ AND SIGNED BY APPLICANT This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history, criminal record, and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and leasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. Date Signature